Dust, Surface Mold or Particle Single-Sample Chain of Custody Form & Mailing Instructions Mail to: MAIL TO: [Mail this form with your sample to an environmental test lab of your choice. Please do not send your sample to us without prior agreement.] _______________________________________ _______________________________________ _______________________________________
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| Name | ||
| Mailing Address | ||
Telephone (1) |
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| Email (2) | ||
| Sampling Address |
The identity and address of the building or location from which the samples were collected. |
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| Sampling Area Descriptions |
A general description of the building conditions such as evidence of visible mold, leak history, other comments. |
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Sample Description |
More than one sample? use our Chain of Custody Form to number, identify, & describe |
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| Signature & Sample Collection Date / Time |
Sign: | Collection Time & Date |
| Payment | Your check for the lab fee. Lab Fee Schedule and Payment Instructions are below. |
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PLEASE DO NOT REQUIRE A RECEIPT SIGNATURE on packages sent to the lab. Failure to follow this suggestion will delay
processing of your sample or may result in the
sample being returned to you without processing. If you are using the U.S. Post Office's
Express Mail be sure to
check and sign the signature waiver box on the mailing label.
01/20/2013 - 05/22/1988 - InspectAPedia.com/sickhouse/Sample_Mailing_Instructions.htm & sickhouse/Sample_Mailing_Instructions.htm - © 2011 - 1988 Copyright Daniel Friedman All Rights Reserved